Left-colon water exchange preserves the benefits of whole colon water exchange at reduced cecal intubation time conferring significant advantage in diagnostic colonoscopy — a prospective, randomized controlled trial

Abstract

Objectives: Whole-colon water exchange (WWE) reduces insertion pain, increases cecal intubation success and adenoma detection rate, but requires longer insertion time, compared to air insufflation (AI) colonoscopy. We hypothesized that water exchange limited to the left colon (LWE) can speed up insertion with equivalent results. Methods: This prospective, randomized controlled study (NCT01735266) allocated patients (18–80 years) to WWE, LWE or AI group (1:1:1). The primary outcome was cecal intubation time. Results: Three hundred subjects were randomized to the WWE (n = 100), LWE (n = 100) or AI group (n = 100). Ninety-four to ninety-five per cent of patients underwent diagnostic colonoscopy. Baseline characteristics were balanced. The median insertion time was shorter in LWE group (4.8 min (95%CI: 3.2–6.2)) than those in WWE (7.5 min (95%CI: 6.0–10.3)) and AI (6.4 min (95%CI: 4.2–9.8)) (both p < 0.001) groups. The cecal intubation rates in unsedated patients of the two water exchange methods (WWE 99%, LWE 99%) were significantly higher than that (89.8%) in AI group (p = 0.01). The final success rates were comparable among the three groups after sedation was given. Maximum pain scores and number of patients needing abdominal compression between WWE and LWE groups were comparable, both lower than those in AI group (p < 0.05). No significant difference was observed regarding PDR, although the PDR in right colon tended to be higher in WWE group. Conclusion: By preserving the benefits of WWE and reducing insertion time, LWE is appropriate for diagnostic colonoscopy, especially in settings with tight scheduling of patients. The higher PDR in the right colon in WWE group deserves to be further investigated.